A propensity-matched study of the association between optimal folic acid supplementation and birth defects in Shaanxi province, Northwestern China
A propensity-matched study of the association between optimal folic acid supplementation and birth defects in Shaanxi province, Northwestern China
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中国西北陕西省最佳叶酸补充与出生缺陷关系的倾向匹配研究
DOI：
10.1038/s41598-019-41584-5
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发表时间：
2019-03-27
影响因子：
4.6
通讯作者：
Dang, Shaonong
中科院分区：
文献类型：
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作者：
Qu, Pengfei;Li, Shanshan;Dang, Shaonong
补充叶酸与神经管缺陷以外的出生缺陷之间的关系仍不清楚。我们利用一项大型人口调查的数据来研究中国西北地区叶酸补充剂与出生缺陷之间的关联。采用分层多阶段抽样方法，对中国西北地区陕西省2010年至2013年期间出生的29,204名婴儿妇女进行了调查。使用倾向评分将 9,293 名叶酸补充最佳的女性与 9,293 名叶酸补充非最佳的女性进行匹配，并通过条件逻辑回归模型评估最佳叶酸补充对出生缺陷的影响。倾向评分匹配后，叶酸补充最佳的女性总体出生缺陷率、心血管系统缺陷率和神经系统缺陷率均低于叶酸补充非最佳的女性（总体出生缺陷：OR = 0.71，95% CI = 0.57~0.89，P = 0.003；心血管系统缺陷： OR = 0.65，95% CI = 0.44–0.96，P = 0.032；神经系统缺陷：OR = 0.13，95% CI = 0.02–0.99，P = 0.049）。最佳叶酸补充与出生缺陷患病率降低相关，尤其是心血管系统和神经系统。我们的研究结果对于出生缺陷高发国家（例如中国）通过补充叶酸进行出生缺陷干预具有重要意义。
The association between folic acid supplementation and birth defects other than neural tube defects remains unclear. We utilized data from a large population-based survey to examine the association between folic acid supplementation and birth defects in Northwestern China. A total of 29,204 women with infants born between 2010 and 2013 were surveyed in Shaanxi province, Northwestern China, using a stratified multistage sampling method. Propensity scores were used to match 9,293 women with optimal folic acid supplementation with 9,293 women with nonoptimal folic acid supplementation, and the effects of optimal folic acid supplementation on birth defects were assessed by a conditional logistic regression model. After propensity score matching, the overall birth defect rate, cardiovascular system defect rate and nervous system defect rate for the women with optimal folic acid supplementation were lower than those for the women with nonoptimal folic acid supplementation (overall birth defects: OR = 0.71, 95% CI = 0.57–0.89, P = 0.003; cardiovascular system defects: OR = 0.65, 95% CI = 0.44–0.96, P = 0.032; nervous system defects: OR = 0.13, 95% CI = 0.02–0.99, P = 0.049). Optimal folic acid supplementation was associated with a decreased prevalence of birth defects, especially in the cardiovascular system and nervous system. Our findings have important implications for birth defect intervention with folic acid supplementation for countries with a high prevalence of birth defects, such as China.